The University of Southampton
University of Southampton Institutional Repository

Mortality in sickle cell anemia in africa: A prospective cohort study in Tanzania

Mortality in sickle cell anemia in africa: A prospective cohort study in Tanzania
Mortality in sickle cell anemia in africa: A prospective cohort study in Tanzania

Background:The World Health Organization has declared Sickle Cell Anemia (SCA) a public health priority. There are 300,000 births/year, over 75% in Africa, with estimates suggesting that 6 million Africans will be living with SCA if average survival reaches half the African norm. Countries such as United States of America and United Kingdom have reduced SCA mortality from 3 to 0.13 per 100 person years of observation (PYO), with interventions such as newborn screening, prevention of infections and comprehensive care, but implementation of interventions in African countries has been hindered by lack of locally appropriate information. The objective of this study was to determine the incidence and factors associated with death from SCA in Dar-es-Salaam.Methods and Findings:A hospital-based cohort study was conducted, with prospective surveillance of 1,725 SCA patients recruited from 2004 to 2009, with 209 (12%) lost to follow up, while 86 died. The mortality rate was 1.9 (95%CI 1.5, 2.9) per 100 PYO, highest under 5-years old [7.3 (4.8-11.0)], adjusting for dates of birth and study enrollment. Independent risk factors, at enrollment to the cohort, predicting death were low hemoglobin (<5 g/dL) [3.8 (1.8-8.2); p = 0.001] and high total bilirubin (≥102 μmol/L) [1.7 (1.0-2.9); p = 0.044] as determined by logistic regression.Conclusions:Mortality in SCA in Africa is high, with the most vulnerable period being under 5-years old. This is most likely an underestimate, as this was a hospital cohort and may not have captured SCA individuals with severe disease who died in early childhood, those with mild disease who are undiagnosed or do not utilize services at health facilities. Prompt and effective treatment for anemia in SCA is recommended as it is likely to improve survival. Further research is required to determine the etiology, pathophysiology and the most appropriate strategies for management of anemia in SCA.

1932-6203
Makani, Julie
76a145a7-02fc-43ea-a1df-3a52d2004e48
Cox, Sharon E.
6194d12c-fea6-4bff-b49a-4784928812f5
Soka, Deogratius
a9467ecf-9fb7-4bd3-805d-36d1cae72f7c
Komba, Albert N.
00004ff2-9113-426a-8e7d-91d0a25dd172
Oruo, Julie
62bc5061-4c40-4866-b2d9-5f1cf3ff6fb1
Mwamtemi, Hadija
f52a5df7-fb68-4536-92b6-9186fd3632e8
Magesa, Pius
c985c7bc-77d3-4da5-a170-32ccf4ee7543
Rwezaula, Stella
e53c9209-221b-4a45-97c4-17ebacf323dc
Meda, Elineema
ee3ff767-895e-4d3f-804f-3a749700a350
Mgaya, Josephine
740b5114-40dc-4020-bbe0-c54475f34328
Lowe, Brett
30feded0-3d02-4cf2-b89c-5e86359825e2
Muturi, David
13b562b1-bc42-49d8-908c-3d9c982dd944
Roberts, David J.
67d9b234-4b0f-4d3c-9116-ae8035f97230
Williams, Thomas N.
35087fc8-4ba4-4730-94cb-db91ff13d58b
Pallangyo, Kisali
088a99af-52a8-40c0-bc42-f4fd7906bc7b
Kitundu, Jesse
bf011bd1-51ac-45ad-99c7-0a3adada74b8
Fegan, Gregory
665c804f-5687-40f3-b40c-ccd88540f7aa
Kirkham, Fenella J.
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Marsh, Kevin
6da72983-5d59-4c53-ad4d-cfccd5da3dda
Newton, Charles R.
ea661613-9a2d-4e14-8d04-2d1c0804a321
Makani, Julie
76a145a7-02fc-43ea-a1df-3a52d2004e48
Cox, Sharon E.
6194d12c-fea6-4bff-b49a-4784928812f5
Soka, Deogratius
a9467ecf-9fb7-4bd3-805d-36d1cae72f7c
Komba, Albert N.
00004ff2-9113-426a-8e7d-91d0a25dd172
Oruo, Julie
62bc5061-4c40-4866-b2d9-5f1cf3ff6fb1
Mwamtemi, Hadija
f52a5df7-fb68-4536-92b6-9186fd3632e8
Magesa, Pius
c985c7bc-77d3-4da5-a170-32ccf4ee7543
Rwezaula, Stella
e53c9209-221b-4a45-97c4-17ebacf323dc
Meda, Elineema
ee3ff767-895e-4d3f-804f-3a749700a350
Mgaya, Josephine
740b5114-40dc-4020-bbe0-c54475f34328
Lowe, Brett
30feded0-3d02-4cf2-b89c-5e86359825e2
Muturi, David
13b562b1-bc42-49d8-908c-3d9c982dd944
Roberts, David J.
67d9b234-4b0f-4d3c-9116-ae8035f97230
Williams, Thomas N.
35087fc8-4ba4-4730-94cb-db91ff13d58b
Pallangyo, Kisali
088a99af-52a8-40c0-bc42-f4fd7906bc7b
Kitundu, Jesse
bf011bd1-51ac-45ad-99c7-0a3adada74b8
Fegan, Gregory
665c804f-5687-40f3-b40c-ccd88540f7aa
Kirkham, Fenella J.
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Marsh, Kevin
6da72983-5d59-4c53-ad4d-cfccd5da3dda
Newton, Charles R.
ea661613-9a2d-4e14-8d04-2d1c0804a321

Makani, Julie, Cox, Sharon E., Soka, Deogratius, Komba, Albert N., Oruo, Julie, Mwamtemi, Hadija, Magesa, Pius, Rwezaula, Stella, Meda, Elineema, Mgaya, Josephine, Lowe, Brett, Muturi, David, Roberts, David J., Williams, Thomas N., Pallangyo, Kisali, Kitundu, Jesse, Fegan, Gregory, Kirkham, Fenella J., Marsh, Kevin and Newton, Charles R. (2011) Mortality in sickle cell anemia in africa: A prospective cohort study in Tanzania. PLoS ONE, 6 (2), [e14699]. (doi:10.1371/journal.pone.0014699).

Record type: Article

Abstract

Background:The World Health Organization has declared Sickle Cell Anemia (SCA) a public health priority. There are 300,000 births/year, over 75% in Africa, with estimates suggesting that 6 million Africans will be living with SCA if average survival reaches half the African norm. Countries such as United States of America and United Kingdom have reduced SCA mortality from 3 to 0.13 per 100 person years of observation (PYO), with interventions such as newborn screening, prevention of infections and comprehensive care, but implementation of interventions in African countries has been hindered by lack of locally appropriate information. The objective of this study was to determine the incidence and factors associated with death from SCA in Dar-es-Salaam.Methods and Findings:A hospital-based cohort study was conducted, with prospective surveillance of 1,725 SCA patients recruited from 2004 to 2009, with 209 (12%) lost to follow up, while 86 died. The mortality rate was 1.9 (95%CI 1.5, 2.9) per 100 PYO, highest under 5-years old [7.3 (4.8-11.0)], adjusting for dates of birth and study enrollment. Independent risk factors, at enrollment to the cohort, predicting death were low hemoglobin (<5 g/dL) [3.8 (1.8-8.2); p = 0.001] and high total bilirubin (≥102 μmol/L) [1.7 (1.0-2.9); p = 0.044] as determined by logistic regression.Conclusions:Mortality in SCA in Africa is high, with the most vulnerable period being under 5-years old. This is most likely an underestimate, as this was a hospital cohort and may not have captured SCA individuals with severe disease who died in early childhood, those with mild disease who are undiagnosed or do not utilize services at health facilities. Prompt and effective treatment for anemia in SCA is recommended as it is likely to improve survival. Further research is required to determine the etiology, pathophysiology and the most appropriate strategies for management of anemia in SCA.

Other
journal.pone.0014699 - Version of Record
Available under License Creative Commons Attribution.
Download (227kB)

More information

Accepted/In Press date: 7 January 2011
Published date: 16 February 2011

Identifiers

Local EPrints ID: 429228
URI: http://eprints.soton.ac.uk/id/eprint/429228
ISSN: 1932-6203
PURE UUID: 11d782a8-0a23-4a62-9a27-29f0e7dfce04
ORCID for Fenella J. Kirkham: ORCID iD orcid.org/0000-0002-2443-7958

Catalogue record

Date deposited: 22 Mar 2019 17:30
Last modified: 16 Mar 2024 03:22

Export record

Altmetrics

Contributors

Author: Julie Makani
Author: Sharon E. Cox
Author: Deogratius Soka
Author: Albert N. Komba
Author: Julie Oruo
Author: Hadija Mwamtemi
Author: Pius Magesa
Author: Stella Rwezaula
Author: Elineema Meda
Author: Josephine Mgaya
Author: Brett Lowe
Author: David Muturi
Author: David J. Roberts
Author: Thomas N. Williams
Author: Kisali Pallangyo
Author: Jesse Kitundu
Author: Gregory Fegan
Author: Kevin Marsh
Author: Charles R. Newton

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×